Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Macrophages play an important role in material-related immune responses and bone formation, but the functionality of macrophage-derived extracellular vesicles (EVs) in material-mediated bone regeneration is still unclear. Here, we evaluated intracellular communication through small extracellular vesicles (sEVs) and its effects on endogenous bone regeneration mediated by biomimetic intrafibrillarly mineralized collagen (IMC). After implantation in the bone defect area, IMC generated more neobone and recruited more mesenchymal stem cells (MSCs) than did extrafibrillarly mineralized collagen (EMC). More CD63
Biomimetics ; Bone Regeneration ; Cell Differentiation ; Collagen ; Extracellular Vesicles ; Macrophages ; Osteogenesis

Objective:To understand the genetic variation of soft tissue sarcomas, and to provide a scientific evidence for the individualized treatment.Methods:The somatic mutation and germline mutation of 45 adult soft tissue sarcomas had been detected by high-throughput sequencing technology, the clinical data were also analyzed.Results:A total of 88 gene mutations were detected in 45 samples, including 78 single nucleotide variation (SNV), 13 insertion/deletion (Indel) and 19 copy number variation (CNV). The most common mutant genes are TP53, CDKN2A, MDM2, CDK4, NF1 and PTEN. Among them, the mutation rates of TP53-MDM2/MDM4-CDKN2A pathway, CDKN2A/CDK4/RB1 pathway, and RAS/NF1/PTEN/PI3K pathway were more frequent (32/88, 36%). In terms of immunotherapy biomarkers among 10 samples, the median value of tumor mutation burden was 2.02 muts/Mb (0-4.24 muts/Mb), and all were microsatellite stable.Conclusions:This study analyzes the genetic variation of soft tissue sarcoma, and determines the high-frequency gene mutations and pathways, which may be the potential drug targets. This finding can provide scientific evidences for the personalized treatment of soft tissue sarcoma.

Objective:To understand the genetic variation of soft tissue sarcomas, and to provide a scientific evidence for the individualized treatment.Methods:The somatic mutation and germline mutation of 45 adult soft tissue sarcomas had been detected by high-throughput sequencing technology, the clinical data were also analyzed.Results:A total of 88 gene mutations were detected in 45 samples, including 78 single nucleotide variation (SNV), 13 insertion/deletion (Indel) and 19 copy number variation (CNV). The most common mutant genes are TP53, CDKN2A, MDM2, CDK4, NF1 and PTEN. Among them, the mutation rates of TP53-MDM2/MDM4-CDKN2A pathway, CDKN2A/CDK4/RB1 pathway, and RAS/NF1/PTEN/PI3K pathway were more frequent (32/88, 36%). In terms of immunotherapy biomarkers among 10 samples, the median value of tumor mutation burden was 2.02 muts/Mb (0-4.24 muts/Mb), and all were microsatellite stable.Conclusions:This study analyzes the genetic variation of soft tissue sarcoma, and determines the high-frequency gene mutations and pathways, which may be the potential drug targets. This finding can provide scientific evidences for the personalized treatment of soft tissue sarcoma.

Objective: To investigate the feasibility of parameter-optimized magnetic resonance imaging (MRI) as the first choice for imaging examination in patients with acute ischemic stroke (AIS), and to assess the effects of quality improvement (QI) measures on shortening the door-to-needle time (DNT). Methods: A retrospective case-control study was conducted. A total of 69 AIS patients hospitalized at the Department of Neurology of the People's Hospital of Wuzhou from August 2015 to July 2018 were enrolled in the study, and the head MRI was used as the first choice for imaging examination. All patients received the intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). Patients with AIS undergoing intravenous thrombolysis from August 2015 to March 2017 were included in the control group, and those receiving intravenous thrombolysis after QI measures from April 2017 to July 2018 were included in the experimental group. QI included informing the stroke team in advance by emergency physicians, treatment process changing from serial procedure to the parallel one, optimization of MRI scanning parameters, and use of rapid test instruments. The MRI scanning time was compared between the two groups. The DNT of the two groups was compared, and paired-samples t test was used. The proportion of patients who underwent MRI scan and DNT<60 min was compared between the two groups, and the χ² test was used. Results: Compared with the control group, the proportion of patients undergoing MRI scan in the experimental group was increased (82% vs 58%, χ²=4.58, P=0.032); MRI scanning time was shortened (4 min 37 s vs 10 min 21 s); DNT (min) was shortened (59.32±10.19 vs 93.48±24.81, t=7.189, P<0.01); and the proportion of patients with DNT<60 min was significantly increased (68% vs 6%, χ²=27.190, P<0.01). Conclusion Parameter-optimized MRI as the first choice for imaging examination in AIS patients with the onset time <4.5 h was feasible, and the DNT was significantly shortened by QI measures.

Objective To probe into the clinical application value of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion weighted imaging (DWI) in identifying benign and malignant breast lesions.Methods 60 patients with clinically suspected breast lesions underwent MR examination.Morphologic features,early enhancement rate,time-signal intensity curve (TIC),apparent diffusion coefficient (ADC) value,as well as the differences between ADC values of the surrounding normal tissues and these of the lesions were compared and analyzed.Results The areas under the receiver operating characteristic curves (AUC) of the early enhancement rate,TIC,ADC value,ADC difference value were 0.741,0.808,0.882 and 0.959,respectively;the best diagnostic thresholds for the early enhancement rate,ADC value,and ADC difference value were 163％,1.30× 10-3 mm2/s and 0.47× 10-3 mm-2/s,respectively.The sensitivity of morphologic features,early enhancement rate,type Ⅲ curve,type Ⅱ and type Ⅲ curve,ADC value and ADC difference value in differentiating benign and malignant breast lesions was 53.1％,59.4％,43.8％,90.6％,93.8％ and 96.9％,respectively;the specificity was 85.7％,82.1％,89.3％,57.1％,75.0％ and 82.1％,respectively;the positive predictive values were 81.0％,79.2％,82.4％,70.7％,81.1％ and 86.1％,respectively;the negative predictive values were 61.5％,63.9％,58.1％,84.2％,91.3％ and 95.8％,respectively;and the accuracy was 68.3％,70.0％,65.0％,75.0％,85.0％,90.0％,respectively.Conclusion DCDMRI and DWI play important roles in differential diagnosis of benign and malignant breast lesions,among which ADC difference value is associated with the highest diagnostic capability.Combination of multiple imaging diagnostic methods is necessary to improve the diagnostic accuracy of breast lesions.

Objective To explore the execution and effect of family-focused psychoeducational therapy for patients with anovulatory infertility .Methods We used the convenient sampling method to choose 110 out-patients with ovulatory infertility that came from the Reproduction Unit of hospital during January to October 2013 .Patients were randomly divided into intervention group and control group on average .On the basis of normal treatment and care , patients in the intervention group underwent family-focused psychoeducational therapy.Six month later, we compared the scores of symptom checklist 90 ( SCL-90 ), family function ( APGAR ) and social support rating scale ( SSRS ) .Results Before intervention , there was no statistical difference between two groups in SCL-90, APGAR and SSRS (P>0.05).After intervention, the scores of SCL-90, somatization, obsessive symptom, interpersonal relationship, depression, anxiety, hostile, terror, crankiness and psychoticism acquired (35.23 ±9.82), (0.15 ±0.14), (0.27 ±0.14), (0.35 ±0.18), (0.25 ±0.15), (0.23 ±0.11), (0.29 ±0.27), (0.17 ±0.13), (0.21 ±0.25) and (0.19 ±0.22) respectively in the intervention group that all were lower than those ( 129.65 ±20.53, 1.24 ±0.41, 1.38 ±0.59, 1.51 ±0.44, 1.73 ±0.39, 1.78 ±0.28, 1.32 ±0.74, 0.89 ±0.39, 1.39 ±0.46, 1.22 ± 0.39, respectively)in the control group (t=-26.748, -10.140, -13.973, -14.215, -16.623, -16.374, -11.351, -8.963, -8.966, -13.867, respectively;P<0.01).In the intervention group, the satisfactory rate of APGAR obtained 87.3%(48/55) after intervention which was higher than 27.3%(15/55) in the control group (χ2 =42.225,P<0.01).The score of SSRS acquired (36.19 ±8.77) in the intervention group better than (28.21 ±7.06) in the control group after intervention (t=12.408, P<0.01).Conclusions Based on routine treatment and care , family-focused psychoeducational therapy can improve the psychological status and pregnancy rate for patients with ovulation disorder , and improve family function and social support .Therefore, it can be used as auxiliary means in clinical treatment , and be worth of spreading .

Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Tibial Fractures ; surgery

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.

Objective To investigate the effect of mesenchymal stem cells (MSCs) on subcutaneous xenograft tumors in mice with Lewis lung cancer. Methods MSCs isolated from bone marrow of C57BL/6 mice were made into single cell suspension and were cultured in vitro. The cells of the 4th to 5th passage were used for the subsequent experiments. Fifty six C57BL/6 mice were inoculated subcutaneously with Lewis lung cancer cells, and were grouped into Group D0 (MSCs were given simultaneously with inoculation)and Group D10(MSCs were given 10 d after inoculation). Group D0 included three subgroups (n=8): Group 1 with inoculation of tumor cells, Group 2 with inoculation of tumor cells and MSCs, and Group 3 with inoculation of tumor cells and tail intravenous injection of MSCs. Group D10 included four groups: Group 4 with inoculation of tumor cells and injection of MSCs in tumors, Group 5 with equivalent PBS (the control of Group 4), Group 6 with inoculation of tumor cells and tail intravenous injection of MSCs, and Group 7 with equivalent PBS (the control of Group 6). The time of tumor formation and the volume of tumor were observed and compared among the groups. ResultsIn Group D0, earlier onset of tumor development was observed in Group 2 as compared to Group 1 and Group 3 (P<0.05), while there was no significant difference on the volume of tumor in the three groups (P>0.05). In Group D10, the volume of tumors were larger in Group 4 compared to the control (P<0.05), while there was no significant difference on the volume of tumors between Group 6 and the control (P>0.05). Conclusion Inoculating mixture of MSCs and Lewis lung cancer cells accelerates tumor formation,and injection of MSCs in tumors stimulates the growth of tumors.